Lupus presents a significant diagnostic challenge. If you were a physician, would you prefer to err on the side of incorrectly diagnosing lupus in an individual without the disease or to miss the diagnosis of lupus in an individual who has the disorder? Which misdiagnosis would you worry about most if you thought the patient might file a medical malpractice suit?
Linda R
I am not a physician but a lupus patient. I also work with lupus patients on a daily basis.
Lupus is autoimmune. There are some 80 autoimmune disorders. Although arriving as a specific diagnosis of lupus is difficult, it is less difficult to arrive at the conclusion that the problems are autoimmune. Often, when a doctor suspects lupus and can't come to a conclusion, the patient is diagnosed as having undifferentiated mixed connective tissue disorder. In addition, autoimmunes usually occur in overlap with one another, further confusing the diagnositic process.
Complications of lupus can be fatal. Half of all lupus patients will have lupus nephritis. I would hope a good diagnositician who suspects lupus would regularly monitor kidney function. There are no physical symptoms of lupus nephritis until it is very serious, usually over 3,200 mg protein in the urine in 24 hours. Seems prudent to monitor that. High levels of protein in the urine would suggest lupus nephritis and may warrant a kidney biopsy which would be a significant factor in arriving at a lupus diagnosis.
Additionally, the patient should be screened for APS, antiphospholipid anitbody syndrome, which includes lupus anticoagulant and anticardiolipin. Failure to identify this syndrome, which can occur on its own or along with SLE could result in death by cardiovascular event as well as a high incidence of premature births and spontaneous abortions.
Bottom line, an internist or general practitioner would be wise to refer a suspected lupus patient to and experienced rheumatologist for diagnosis. Lupus is very complicated. The rheumatologist would likely refer the patient to various specialists. (I have quite a few).
It is my experience that rheumatologists are very brave doctors, willing to prescribe and treat complications of lupus when others run in the opposite direction! My oral surgeon would not even prescribe prophylactic antibiotics or pain meds, but deferred to the rheumy!!!!
Here's to the courage of rheumatologists!!!
Orignal From: Tips: question the disease Lupus?
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